i got started on a mhm post for this week and, as sometimes happens, realised that i'd bit off a little more than i could chew in a day and a half. hopefully, i'll have that ready for you next week, but in the meantime, i thought i'd return to a subject that's received surprisingly little attention here. [and whose fault is that? -ed.] personality disorders are poorly understood even in terms of mental illness, because they seem to be linked more to learned behaviour than to brain chemistry. that's a grotesque over-simplification, because mood disorders are often treated with the same medications as conditions like depression and anxiety, and type i disorders usually require some type of behavioural therapy in conjunction with medication. plus, of course, that there's nothing saying you can't have both types of disorder going on at the same time. [brains are very evil and nasty things and it kind of sucks that you can't get by without one, although it some people do seem to manage.]

there are a lot of issues surrounding personality disorders, including how they're diagnosed [often quite differently between men and women], the perceived arbitrariness with which they're defined and accepted, the perceived stigmatization of certain character traits and their potential [ab]use in explaining socially unacceptable behaviour. the post below doesn't deal with any of that. it's just a basic introduction to the world of personality disorders, how they're [currently] defined and what makes them different from other types of disorders.

as a brief aside, one of the most controversial subjects associated with personality disorders is that they are often linked to prevailing morals of the time rather than hard science. [although, when it comes to the brain, hard science is a tricky concept in itself.] labeling people as mentally ill because they are different carries some pretty horrifying baggage. nonetheless, one of the things that treating personality disorders does [or is supposed to do] is to liberate the sufferer from the baseless anxieties that can impair their ability to function and feel happy or at ease. so to that end:

is it time to look at extreme examples of racism, sexism or homophobia as anxiety-based personality disorders?

there's a fair amount to think about there, and i'm capable of playing devil's advocate on either side. i'm putting the question out there in case anyone else has thought about it.

oh, and for those of you who hadn't figured out the answer to last week's brain teaser [or looked it up on line], cheryl's birthday is july 16th. according to the readers of mental health mondays, however [you can see the comments on facebook], the proper answer is "cheryl is a cunt". [those aren't mutually exclusive. -ed.]

much
of our conception of mental disorders is wrapped up in the "biggies",
things like schizophrenia and bipolar disorder that tend to result in
dramatic deviations from "normal" behaviour [even though they sometimes
don't] and reasoning. but really, that's just the top layer of the crazy
tiramisu. there are many further classifications of thought and mood
disorders that don't get spoken about as much, but which may affect far
larger numbers of people. they also tend to be more controversial,
because they are less evident. someone who refuses to eat and bathe or
speaks to people who aren't there or who cuts themselves because they
believe that they have bugs living under their skin is obviously in need
of help. someone who is prone to wild exaggeration or who thinks only
of themselves often seems more in need of a boot to the head.
ultimately, the fear is that behaviour which is merely odd or eccentric
can be labeled as disordered thought, which obviously raises a lot of
questions about the limits of individuality. i'm not going to get into
the arguments for and against, that's for another day [and should
probably involve a lot more voices besides mine]. this is just a quick
introduction.

generally speaking, personality disorders
are a group of symptoms established over the long term in an adult
personality that affects or compromises an individual's thought patterns
and interactions with and beliefs about the outside world. so what the
hell does that mean?

I PROBABLY CAN'T ANSWER THAT QUESTION, BUT THERE'S MORE TO READ...

well,
the crux of the matter seems to be where one draws the boundaries of
normal or rational behaviour and the value of moderation. if you accept
that one should be moderately social, moderately trusting, moderately
emotional, moderately independent and moderately empathetic then it
stands to reason that behaviour that falls outside the bounds of
"moderation" is abnormal. of course, you then have to establish a
standard of normalcy, which will obviously have some dependence on
dominant cultural values and open a whole can of social worms that i
said in the opening paragraph i was going to try to avoid. i hope this
serves as an example of the complexity of the issue.

personality
disorders are grouped into "clusters" both by the american psychiatric
association and the world health organisation. the clusters are
delineated by the perceived core elements of the disorders, although
there is also a category reserved for personality disorders "not
otherwise specified" [i.e., "something is wrong with you, but we don't
have a name for it yet"]. furthermore, the w.h.o. has a classification
for mixed personality disorders [i.e., "you have a whole lot of things
wrong with you"].

the a.p.a. names their clusters [the w.h.o. doesn't] ::

a. odd or eccentric disorders [remember what i said at the beginning about stigmatising certain behaviour?]

b. dramatic, emotional or erratic disorders

c. anxious or fearful disorders

navigating
the waters of these personality disorders can get very rough very
quickly. for starters, the naming of the disorders themselves seems to
be some sort of psychiatric trap. among the disorders in cluster "a",
you have both schizotypal AND schizoid personality disorder [although
the w.h.o. only lists the latter]. those are two different disorders,
the first characterised by abnormal [loaded term, i know] or eccentric
thought, superstitious or irrational beliefs and the second by social
withdrawal, marked introversion and apathy. and both are very different
from schizophrenia. of course, all three can share symptoms. and you can
have both schizophrenia and a comorbid personality disorder [schizo
squared?]. confused yet? no?

how
about defining obsessive-compulsive disorder versus obsessive
compulsive personality disorder? the first is an axis i condition, where
a person feels forced for reasons they can't always explain to perform
certain rituals, avoid certain things, or follow certain guidelines. the
personality disorder variant is extremely similar, manifesting as a
strict adherence to order and process, often at the expense of
flexibility and efficiency. the main difference between the two? in the
axis i disorder, the subject finds their compulsions frightening or
unpleasant. an individual with the personality disorder variant believes
that their methods are correct. good luck figuring out where the
dividing line falls on that one. if i need to get up in the morning and
start my day by making a detailed list of everything i need to do, even
on days when i don't want to, because i think it's the right thing to
do, does that mean i have obsessive-compulsive disorder or
obsessive-compulsive personality disorder? or does it just make me
well-organised?

theoretically, the difference between
being charmingly eccentric and in need of help falls at the point where
one's eccentricities start controlling and interfering with everyday
life. if i make a to-do list every morning when i get up, that's one
thing. if i wake up two hours late and still can't leave the house
without taking the time to write out my list, or if i spend the entire
day too anxious to do anything because i'm afraid of not knowing what
i'm supposed to be doing, that's a problem. in general, then, we can say
that one's level of flexibility is what's at question, but it's not
always so easy to sort things into one pile or another. and that's
assuming that, as a subject, i even perceive that i have a problem. most
people with personality disorders actually believe quite the opposite;
they think that they see things more clearly and accurately than others.
which raises the question of who gets to decide when a behavioural
quirk becomes problematic. if i don't think i have a problem, should
that be good enough? would it be good enough if i were a drug addict?
it's a very slippery slope.

in
keeping with the somewhat vague criteria for defining personality
disorders, their causes are likewise somewhat difficult to predict.
there does seem to be some genetic predisposition,
in that people with a family history of mental disorders of any kind
are more likely to produce children with personality disorders, but no
one has come up with a reason why. childhood experiences
seem to be a major factor, whether it means some sort of abuse, neglect
or general instability, which could technically mean that personality
disorders are actually a long-term effect of post-traumatic stress
disorder, the brain's way of orienting itself towards the world in
reaction to extreme stress. and then there's the fact that personality
disorders seem to disproportionately affect those who have "low
socioeconomic status". so on top of all the other misery it brings into
your life, being poor may make you crazy.

as tricky as
they are to define, personality disorders are even trickier to treat.
medications may help manage some of the acute symptoms of the disorder,
but therapy, usually structured to identify the causes of disordered
thought patterns and to "train" the mind to think in a different, less
damaging way, is thought to be the route to a permanent recovery. i say
that it is "thought to be", because the fact is that there is
comparatively little research on personality disorders, so theories
about a cure are still highly, well, theoretical. [this may be a side
effect of those who may have disorders not admitting that they do. if i
don't believe i have a problem, why would i present myself for treatment
or analysis?]

if this all seems excessively
complicated, it's because it probably is. and it warrants further
discussion and study. but for today, we'll leave off there. more on the
subject at a later time.

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